Breast surgery

Surgery for breast cancer is the indicated treatment for tumor removal, the removal of the breast itself and also the area around it. It's one of the most used procedures against this type of cancer, which also include oral drugs. Know more.
Breast surgery

Surgery is an essential component in treatment for breast cancer. It can be done alone or with other approaches such as chemotherapy, hormone therapy, targeted therapy and radiation therapy. 

Types of surgery for breast cancer

Surgeries performed for breast cancer have different approaches, the main one being the mastectomy. In it, it’s done the complete removal of the breast, and, when necessary, of the other parts around it (so-called security margin). There are several types of mastectomy:

  • Simple mastectomy: It is done the removal of the whole breast, including the nipple, areola and skin. 
  • Skin-sparing mastectomy: Just the breast tissue, nipple and areola are removed, while the most part of the breast skin is preserved. Silicone gel implants or tissue from other parts of the body implants are used to reconstruct the breast. This approach, preferred by many women, has the benefit of smaller scarring tissue, and the reconstructed breast appears more natural. However, sparing mastectomy may not be suitable for bigger tumors or those that are close from the surface of the skin.
  • Nipple-sparing mastectomy: This is the option for women who have small, early-stage tumor, near the outside of the breast, with no signs of disease on the skin or near the nipple. The breast tissue is removed, but the breast skin and nipple are preserved. Soon after, the breast reconstruction is performed.

In some cases, the surgeon may remove breast tissue under the nipple and areola to check for cancer cells. If the presence of the neoplasm is confirmed, the nipple will also be removed.

This kind of surgery has limitations: in some women, the nipple does not have a good blood supply, so it can sometimes wither, become deformed, or even have reduced or lost sensitivity, since the nerves are cut. In terms of aesthetic appearance, this surgery has better results in women with small to medium-sized breasts.

  • Modified radical mastectomy: The mastectomy technique is combined with the removal of the axillary lymph nodes.
  • Radical mastectomy: The whole breast, the axillary lymph nodes, and the pectoral muscles (chest wall) behind the mammary gland are removed. Nowadays, this surgery is hardly performed, being more reserved for larger tumors that are invading the pectoral muscles. 
  • Double or bilateral mastectomy: When the mastectomy is performed on both breasts. Women at high risk of developing cancer in the other breast or those who have a mutation in the BRCA gene usually undergo this surgery.

Another possibility of surgery in the treatment for breast cancer is the breast-conserving surgery, also called lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy. It is a surgery in which only the portion of the breast that contains the cancer is removed. The goal is to remove the cancer and some of the tissue around it and the amount of breast that will be removed depends primarily on the location and the size of the tumor. Currently, it is the most performed surgery. 

An approach for some kinds of breast cancer is the surgery to remove the axillary lymph nodes (glands in the armpit), which the two main types are:

  • Sentinel lymph node biopsy: Procedure in which the surgeon removes only the lymph nodes located in the armpits, as it is the most likely place to where breast cancer spreads. The removal of only one or few lymph nodes reduces the risk of collateral effects of the surgery, such as lymphedema (swelling of the arm where the procedure took place).
  • Axillary lymph node dissection: A procedure in which a greater amount of lymph nodes (usually less than 20) is removed. 

Breast reconstructive surgery after the mastectomy allows women that have had surgery to treat breast cancer to opt for the restoration of the breast appearance. Although each case must be analyzed individually, most patients who have the mastectomy can have immediate reconstruction (in the same surgery) or late reconstruction. 

The main types of reconstructive surgery are:

  • silicone gel implants;
  • grafting with patient’s own fat;
  • breast reduction;
  • breast lift or mastopexy, which repositions the areola and the breast tissue, removing excessive skin;
  • scar correction; and
  • use of skin and tissue flaps of another region for breast reconstruction.

Besides its curative nature for cancer treatment, surgery can also be done with the objective of preventing it from happening in the future: it’s preventive surgery. Some women with family history of the disease (in close relatives) with confirmed mutated BRCA genes (diagnosed by genetic tests), who received radiation therapy to the thoracic region before age 30, or who had a previous cancer in one of the breast undergo tests to assess their risk of developing the disease. The doctor will review each case to decide if preventive mastectomy is indicated.

Possible adverse effects in surgery

Surgery for breast cancer is a safe surgical procedure, but it carries a small risk of complications, common to all surgeries. The main complications that can occur are:

  • hemorrhage (bleeding);
  • infection;
  • seroma (build up of fluid at the operated site);
  • pain;
  • permanent scar;
  • change or loss of sensibility in chest and breasts
  • difficult in healing; and
  • swelling in the arm (lymphoedema).
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